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� � <br /> APPLICATIO�I FOR GaNSTRUCT.JN PERMIT <br /> theEvergreen ��� everett <br /> CITY OF � <br /> everett <br /> 8UI!_DING DEPARTMENT <br /> 25y-8810 TO BE COMPLETED IN INK—PLEASE PRINT <br /> i 1 DEMOLITION X COMBINATION BUILDING MECHA�IICAL PLUMBING f I SIGN <br /> ��YMER MFILFDORE55 CITY ZIP PHONE <br /> ai�,.�rk P1�<1,�.. 1 `+yc :z 1��7 I)�� L o�.!"! is�<'Q 3.� 3 '/ ? � 7 <br /> TENANT M41L ADDRE55 CITV ZIP PNONE <br /> ARCNRECTORDESIGNER MAILADDflESS CITY Z�P PHONE <br /> GENERRLCONTRAGTOF MAILADDRESS LITY 21P FHONE UCENSE� <br /> /%�'C/.(/ C/.� . /-� 'bj "{. .y ' /_' '�G "f^ <br /> MECH4NICALCONTRACTOR MAILAUDRE55 ' GITV ZIP PMONE LICENS'ce <br /> PIUNBING CONTRRCTOR MAIL p�DRESS qTY ZIP PNONE LICENSE a <br /> CLRSS OF WORK <br /> 'h'NEW !_i ADDITION L! ALTERATION ! REPAIR . �. DEMOLITION . WOODSTOVE/FRPL INSERT .. 1 BUILDING flELOCATION <br /> iENANTIMPROVEMENTORINiEF10P.REMO�EL LV CONiRCTPER50NANDPHONENO. <br /> CONTRRCTPRICEOfWORM. �i , , �,j , �T_ ��+�fi , <br /> DESCRIBE WORN AND SOUARE FOOTAGE INVOLVEO <br /> �v, ��� 3 ,:`�rr� �.2 f�s' �: f^� <br /> Paovos useoFeuaoir+c , ' I HEREBY CEFTIFY THAT I HAVE READ AND EXAMINED THIS <br /> ,��.. J' 2. -, APPLICATION AND KNOW THE SAME TO OE TRUE AND CORRECL ALL <br /> LEGALDESCHPIONOFPROPEFtt�SMOWNOELOWORATTFCNFOIIRCOPIES� PROVISIONSOFLAWSANDORDINANCESGOVERNINGTHISTYPEOF <br /> � WORK WILL BE COMPLETED WITH WHETHEA SPECIFIED HEREIN OR <br /> ioT�_ BLOCK oF.,�/�.� ,,�-Jn � NOT. THE GRANTING OF A PERMIT DOES NOT PRCSUME TO GIVE <br /> AUTHORITV TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> '�,�J C1 �? �y�/OJ,Z OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFOAMANCE OF CONSTflUCTION.THAT I AM AUTHOR�ZED BV THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br /> SIGNATUIiEOFC06fRAC10RORAUTHJRIZEDAGENT OATE <br /> � 3nn ,, a /� .A X � <br /> PRQ1E A�ORE55 ' . 1n` � <br /> —" S� V 6 SC �PPLiCANTS ITVBUSIHESSUCEN'ENO.RNDBUS!NESSNRM1I[ <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TVPE OF EQUIPMENT FEE <br /> WATER CLOSET(TOILET) NC—lvHNDLG UNITS—H.P. <br /> / BATHTUB C� ! FORCED AIR SYSTEMS—B.T.U. M E.A. � <br /> Z LAVATORY(WASH BASIN) UNIT HEATERS—B.T.U. M <br /> SF�OWER � CLOTHES OAVERS � <br /> KITCHEN SINK 8 DISP VENTILATION FAN ; <br /> DISHWASHER 5� R�NGE HOOD <br /> LAUNDRYTRAY WATER HEATER � <br /> CLOTHES WASHER WOOD STOVE <br /> URINAL ' METAL FIREPLACE 8 CHIMNEY <br /> DRINKING FOUNI'AI� FIREPLACE INSERT <br /> FLOOR DRAIN � HEAT PUMP <br /> BACKFLOW PREVENTERS GAS PIPING ; <br /> ROOF DRAINS—RAINLEADERS EXHAUST FAN --� <br /> SINK(SERVICE—BAR,ET(:.) ; i <br /> ; <br /> n � <br /> SUB TOTAL 5 ;Q SUB TOTAL $ <br /> PERMIT 5 PERMIT $ <br /> TOTAL FEE S ' TOTAL FEE 5 <br /> FR]NTSETB�CK �� FEF�C1 ACK �� SI�E'SETOACK�- PLANCII CNN111.1pEg� � F[E�� REf,�P1NQ� <br /> T Y G a. o�o- o� �=o"� <br /> ❑SE20NE �oinnen vncnHisrte FEES VALUATION FEE <br /> �� � <br /> IS � Id �✓ i� VES � I NO S�V eJ3� c � <br /> BUILDING �� J � <br /> �iYPEOFCONSi.FLIOWABLE iY�yiC(1NSi.ACillAl Ottur�ycr hoaowFuixcuvrt5 <br /> GPOJ� <br /> S� �� �' , PWMBING 5� <br /> SRE9 FB UG. NO.OFSTORIEE B�SEId[NT ���YYy,,,www,,,� <br /> fZ6� Srf MECIiANICAL yy�'; �n <br /> _ 4Sz1Sr � . YES :�� NO E7�' <br /> OCCUPpNC LORO FIRESPRNKLE9SRFOD H[IGHTLIMITATION OTHER � <br /> � — i' YES X' NO � <br /> STATE BUILDING SLIRCHARGE (���� <br /> REASON FOR SPRINKLERS - <br /> STATEENERGYSURCHARGE � <br /> APPLICATION FCC.BY PL�NS FPPROVED BV CITY OF EVERETT PUBLIC WOHKS � <br /> Q� LOCAL SALES ' <br /> �� � TAX COOE IS 3105 T�TA� ' <br /> �� �7 <br />